Tuesday, March 8, 2016

Shoulder arthritis in young patients - is 'biological resurfacing' useful?

Biologic resurfacing arthroplasty with acellular human dermal allograft and platelet-rich plasma (PRP) in young patients with glenohumeral arthritis-average of 60 months of at mid-term follow-up.

These authors point to the challenge of treating young patients with glenohumeral arthritis - individuals with high expectations for comfort, function, and longevity.

These authors state, "The treatment of young patients with symptomatic glenohumeral arthritis has been challenging. Total shoulder arthroplasty (TSA) can be associated with accelerated glenoid loosening, eccentric polyethylene wear, and multiple revision surgeries."

As an alternative to total shoulder arthroplasty, they report on patients (age 50±9 years) having hemiarthroplasty and biologic resurfacing of the glenoid with acellular human dermal allograft (GraftJacket MaxForce Extreme) soaked in platelet-rich plasma.   

Ten of 47 patients were satisfied, 28 of 47 patients were highly satisfied (28/47). Five shoulders were revised to anatomic total shoulder arthroplasty. Three cases were revised because of persistent pain. One patient was had a single-stage revision to TSA for infection. Another patient had an intraoperative humeral shaft fracture requiring revision with long-stem prosthesis and eventually underwent revision to TSA. There were 6 additional patients who had poor functional outcomes.

Comment:  Young patients with shoulder arthritis present particular challenges. As emphasized here, the most common types of arthritis are different for older and younger patients(Saltzman JBJS 2010). 

These authors sought to avoid the use of a prosthetic glenoid by inserting another foreign material, GraftJacket. The incremental cost and operating time for this procedure in comparison to hemiarthroplasty or total shoulder is not provided.  It is not apparent that the complication and revision rates are lower or that the outcomes are better for this procedure in comparison to the alternatives of the ream and run or total shoulder arthroplasty in similar patients.


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